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What’s the alternative?

Periodically the debate about whether or not clinicians should prescribe alternative or complementary therapies to their patients pops up in both the scientific and mainstream media. Such a debate along with sundry comments recently appeared on The Conversation blog and also in a slightly different form in the Sydney Morning Herald. In essence, one side of the argument maintains that there is no justification for providing treatments that lack scientific support and the other that it is fine to provide any treatment that the patient feels is beneficial. A similar (but not entirely identical) recurring debate surrounds whether or not clinicians should knowingly provide placebo treatments; Neil O’Connell posted an excellent discussion on this on a little while ago on BIM and BMJ also addressed the issue.

Judging by the chaotic pile of comments to just these few posts alone, peoples’ views range from the dogmatic at either end of the spectrum and include everything in between, with just a bit of the bizarre and irrelevant thrown in for good measure (I’m still struggling to uncover the link to climate change, but maybe that’s because I lack imagination). While I’m under no illusion that my opinion adds anything to this, reading through did give me pause for thought about where we – as early career researchers – fit in to this debate. Obviously many of us are in, or come from, clinical practice and some will hold strong views on one side or the other, in some cases such pondering might even have prompted the move into research. In my opinion the issues are worth considering for a couple of reasons.

Firstly, given what we do for a living there’s every chance that someone will ask your opinion on the topic so it’s probably worth having something coherent to say. The easy out is to quote the Discussion section of nearly every Systematic Review out there and declare that ‘more research is necessary’. On the other hand there is the opportunity to impress friends, relatives and colleagues with a well-considered opinion that requires understanding of both sides of the argument.

Secondly, and probably more significantly, at some point you might be called on ‘defend’ the findings of your research or comment on their implications for clinical practice (which is kind of the ultimate purpose of good quality clinical research right?) This is especially relevant if your findings are at odds with common practice. Such results can be threatening and/or run counter to deeply-held points of view and you should be warned that these discussions don’t always necessarily remain reasonable or even civil, people have turf to protect.

Thirdly, these issues have implications for how research in general should be integrated (or not) into practice. Are we setting rules or informing guidelines? How should Evidence-based practice be operationalised?



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